Staged Approach of Frenectomy Followed by Modified Tunnel and Subepithelial Connective Tissue Graft in Single Mandibular Anterior Recessions: A Clinical Report of Three Cases.

This case report proposes a unique approach for managing Cairo gingival recession types 1 and 2 (RT1 and RT2, respectively) in the mandibular anterior region, where anatomical features such as a high frenal attachment or a shallow vestibule preclude the use of a coronally advanced flap. Three systemically healthy patients presenting with Cairo RT1 and RT2 gingival recessions were included. The recessions were managed with a staged approach of frenectomy followed by a modified tunnel in combination with connective tissue graft. Significant root coverage was achieved in all three cases. This treatment approach allows for root coverage, relief of frenal pull, keratinized tissue gain, and increased vestibular depth in very challenging Cairo RT1 and RT2 gingival recessions in mandibular anterior teeth. A short-term follow-up of 3 to 6 months showed stable results in all presented cases.